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Bladder Cancer (cont.)

How Is Bladder Cancer Staging Determined?

Bladder Cancer Staging

A cancer is described as to its extent, or staged, using a system developed by consensus among specialists in cancer.

Staging describes the extent of the cancer when it is first found or diagnosed. This includes the depth of invasion of a bladder cancer, and whether or not the cancer is still only in the bladder, or has already spread to tissues beyond the bladder including lymph nodes, or has spread or metastasized to distant organs.

Bladder cancers are classified by how deeply they invade into the bladder wall, which has several layers. Typically we subdivide bladder cancer into superficial and invasive diseases.

  • Nearly all adenocarcinomas and squamous cell carcinomas are invasive. Thus, by the time these cancers are detected, they have usually already invaded the bladder wall.
  • Many urothelial cell carcinomas are not invasive. This means that they go no deeper than the superficial layer (mucosa) of the bladder.

In addition to how deeply the cancer penetrates in the bladder wall, the grade of the bladder cancer provides important information and can help guide treatment. The tumor grade is based on the degree of abnormality observed in a microscopic evaluation of the tumor. Cells from a high-grade cancer have more changes in form and have a greater degree of abnormality when viewed microscopically than do cells from a low-grade tumor. This information is provided by the pathologist, a physician trained in the science of tissue analysis and diagnosis.

  • Low-grade tumors are usually less aggressive.
  • High-grade tumors are more dangerous and have a propensity to become invasive even if they are not invasive when first found.
  • Papillary tumors are urothelial carcinomas that grow in narrow, finger-like projections.
  • Benign (noncancerous) papillary tumors (papillomas) grow as projections out into the hollow part of the bladder. These can be easily removed, but they sometimes grow back.
  • These tumors vary greatly in their potential to come back (recur). Some types rarely recur after treatment; other types are very likely to do so.
  • Papillary tumors also vary greatly in their potential to be invasive and become malignant. A small percentage (about 15%) do invade the bladder wall. Some invasive papillary tumors grow as projections both into the bladder wall and into the hollow part of the bladder.

In addition to papillary tumors, bladder cancer can develop in the form of a flat, red (erythematous) patch on the mucosal surface. This is called carcinoma-in-situ (CIS). Although these tumors are superficial, they are often high-grade and have a high risk for becoming invasive.

Of all types of cancer, bladder cancer has an unusually high propensity for recurring after initial treatment if that treatment was only a local removal or excision typically by transurethral resection. Bladder cancer treated in that fashion has a recurrence rate of 50%-80%. The recurring cancer is usually, but not always, of the same type as the first (primary) cancer. It may be in the bladder or in another part of the urinary tract (kidneys or ureters).

Bladder cancer is most common in industrialized countries. It is the fifth most common type of cancer in the United States. It is the fourth most common in men and the ninth in women.

  • Each year, about 67,000 new cases of bladder cancer are expected, and about 13,000 people will die of the disease in the U.S.
  • Bladder cancer affects three times as many men as women. Women, however, often have more advanced tumors than men at the time of diagnosis.
  • Whites -- both men and women -- develop bladder cancers twice as often as other ethnic groups. In the United States, African Americans and Hispanics have similar rates of this cancer. Rates are lowest in Asians.
  • Bladder cancer can occur at any age, but it is most common in people older than 50 years of age. The average age at the time of diagnosis is in the 60s. However, it clearly appears to be a disease of aging, with people in their 80s and 90s developing bladder cancer as well.
  • Because of its high recurrence rate and the need for lifelong surveillance, bladder cancer is among the most expensive cancers to treat on a per patient basis.

What Are the Stages of Bladder Cancer?

As in most cancers, the chances of recovery are determined by the stage of the disease. Stage refers to the size of the cancer and the extent to which it has invaded the bladder wall and spread to other parts of the body. Staging is based on imaging studies (such as CT scans, X-rays, or ultrasound) and biopsy results. Each stage has its own treatment options and chance for cure. In addition, equally important is the grade of the bladder cancer. High-grade tumors are significantly more aggressive and life threatening than low-grade tumors.

  • Stage CIS: Cancer that is flat and is limited to the innermost lining of the bladder; CIS is high-grade
  • Stage Ta: Cancer that is limited to the most superficial mucosal layer (innermost lining) of the bladder and is considered noninvasive
  • Stage T1: Cancer that has penetrated beyond the mucosal layer into the submucosal tissue (lamina propria)
  • Stage T2: Cancer that has invaded part way through the thickness of the muscular bladder wall, into the muscularis propria. It may be into the first half, superficial, or the outer half of the bladder wall, deep.
  • Stage T3: Cancer that has invaded all the way through the thickness of the muscular bladder wall and into surrounding fat. If the extension is only seen under the microscope, it is pT3b, and if a mass is seen outside of the bladder wall, it is called pT3b.
  • Stage T4: Cancer that has invaded adjacent structures, such as the prostate, uterus, seminal vesicles, pelvic wall, abdominal wall, or vagina but not to lymph nodes in the region
  • Staging also includes N and M classifications to define when a cancer has spread to lymph nodes (N) or to distant organs such as the liver, lungs, or bones (M).
    • N0: no lymph node metastases
    • N1: single local lymph node metastasis in the pelvis
    • N2: lymph node metastases to local areas in the pelvis
    • N3: lymph nodes metastases to areas further away in the pelvis, the common iliac nodes
    • M0: no distant metastases
    • M1: distant metastases
Medically Reviewed by a Doctor on 11/23/2016
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